Provider Demographics
NPI:1306301825
Name:BURCHELL, GEMMA
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:BURCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 LAMONTE LN APT 311
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-5411
Mailing Address - Country:US
Mailing Address - Phone:832-493-8170
Mailing Address - Fax:
Practice Address - Street 1:1615 HILLENDAHL BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3402
Practice Address - Country:US
Practice Address - Phone:832-493-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2073908208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation